Healthcare Provider Details

I. General information

NPI: 1003452921
Provider Name (Legal Business Name): SOUND AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 OLD DES PERES RD
SAINT LOUIS MO
63131-1865
US

IV. Provider business mailing address

1010 OLD DES PERES RD
SAINT LOUIS MO
63131-1865
US

V. Phone/Fax

Practice location:
  • Phone: 314-722-4269
  • Fax: 314-729-0101
Mailing address:
  • Phone: 314-722-4269
  • Fax: 314-729-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MS. MINDY D POWELL
Title or Position: PHYSICIAN LIAISON
Credential:
Phone: 314-722-4269